Lecture 27: Pathology of ovary and uterus

Question 1

How does HPV link to cancer formation?

Question 2

Carinomas

Answer 2

epithelial origin
- adenocarcinoma: adrenal epithelium
- squamous cell carcinoma: squamous epithelium
simple epi --> carcinoma
glandular --> adenocarcinoma
squamous --> squamous cell carcinoma
urothelium --> urothelial carcinoma

Question 3

Lymphoma

Answer 3

lymphoid tissue origin

• Hodgkin’s disease
• Non- Hodgkins ( T or B cells)

Question 4

Melanoma

Answer 4

melanocytic cell
adipose tissue --> liposarcoma
neural tissue --> malignant peripheral nerve sheath
bone --> osteosarcoma
Cartilage --> chondosarcoma
muscle --> leiomyo/Rhabdomyosarcoma

Question 5

Sarcoma

Answer 5

mesenchymal (structural cells , holding fat, nerves and bones )
- less common

Question 6

Where can uterine pathologies occur

Answer 6

Uterus + Neighbouring structures: rectum, bladder, sigmoid colon
Note: Ovarian pathologies can easily spread

Question 7

Follicle quantities in the ovary

Answer 7

400,000 primordial follicles –> dormant until puberty –> FSH and Lh release causes 20 follicles to mature each cycle –> 1 out of the twenty reaches maturity and is released –> Menopause –> only a few follicles remain

Question 8

Ovary in H&M section (hameotocilin and EOSM slide)

Answer 8

cortex, stroma, mesothelial lining, follicles, BV, hilum

Question 9

3x Main ovarian tumours

Answer 9

Metastases spread from everywhere to the ovary–>

1. Germ: germ cell tumours (teratoma)
2. Stromal: sex cord stromal tumours (fibroma)
3. Surface: majority of ovarian tumours arise from the surface/fimbrial end of the Fallopian tube

Question 10

What sort of structure is the ovary inherently?

Answer 10

Cystic structure

- ovaries are constantly forming follicular cysts which develop –> mature –> rupture

Question 11

Ovarian tumour table

Question 12

Polycystic ovaries

Answer 12

In cortex –> follicles proliferate but never ovulated –> continued oestrogen stimulation –> no ovulation (no progesterone) –> endometrial hyperplasia and carcinoma
Polycystic ovaries: follicular cyst (never popped)

Question 13

Ovarian neoplasm

Answer 13

multi cystic (solid) areas

• -> once malignant they become increasingly solid
  1. cyst adenoma
  2. mucinous cyst adenomas
  3. serous
  4. mucinous carcinoma
  5. serous carcinoma

Question 14

Histological features of ovarian neoplasm

Answer 14

1. large nuclei

2. course chromatin

Question 15

Dermoid cyst/Teratomas

Answer 15

dermoid cyst –> females try to make baby WITHOUT MALE SPERM –> starts forming structures (e.g. teeth, hair) –> but recapitulates and goes completely wrong

• normally benign, sitting in skin for years
  pot. to develop squamous cel carcinoma in skin

Question 16

relationship b/w stomach and ovary

Answer 16

diffuse gastric cell carcinoma –> often metastasises into ovary
- another stomach carcinoma is Putinburg Signet Ring carcinoma

Question 17

relationship b/w colon and ovary

Answer 17

colorectal carcinoma –> can metastasise –> become cystic –> mimic primary ovarian neoplasm

Question 18

Putinburg carcinoma

Answer 18

Signet ring cell carcinoma (of stomach) –> nucleus on top and cytoplasm below –>

Question 19

length of normal fallopian tube

Answer 19

9-11 cm

Question 20

What does the fallopian tube open into

Answer 20

peritoneal cavity

Question 21

Function of Fallopian tube

Answer 21

ovulation –> follicle rupture and fimbrae align overtop –> ovum enters lumen of FT –> FERTILIZATION occurs in fallopian tubes –> BlastoCYTE move through rest of fallopian tube into Uterus –> blastocyte IMPLANTS into uterus after several days

Question 22

Structure of Fallopian Tube

Answer 22

Plicae: fingerlike projections 
Lining: serous columnar epithelium
cilia: brush egg down towards uterus
- smooth muscle wall lining
Overall: delicate and complex structure that is very vulnerable to inflammation and tumours --> stops plicae movement --> unable to direct egg --> complications

Question 23

Fallopian Tube tumour table

Question 24

Bilateral Salphangitis

Answer 24

Enflamed fimbrial ends stick together –> fallopian tubes fill with puss and blood

Question 25

Serous carcinoma of fallopian tube

Answer 25

tube expanded by tumour growing within | Thicker = Intrapeithelial neoplasm

Question 26

Components of the uterus

Answer 26

Fundus Body Cervix - thick muscle myometrium wall --> so can push grown baby out - endometrial lining --> changes with every cycle --> contains glands and stroma

Question 27

What are the components of the uterine endometrium

Answer 27

1. glands | 2. stroma

Question 28

Function of the endometrium

Answer 28

Note: components = glands and stroma - endometrium contains oestrogen and progesterone hormone receptors --> endometrium develops and shes under oestrogen and progesterone influence Menopause --> no hormones --> no stimulation for regular menstrual cycle --> Endometrium become inactive after menoapuse

Question 29

Menstrual cycle

Answer 29

1. Oestrogen stimulated proliferative stage OVULATION (required to switch stages/hormone stimualtion) 2. Progesterone stimulated secretory stage 3. Menstrual 4. Inactive

Question 30

When is there excessive oestrogen stimulation

Answer 30

1. diabeties | 2. polycystic ovarian syndrome

Question 31

What happens if there is no ovulation?

Answer 31

No switch from oestrogen --> progesterone | oestrogen continues to be released --> excessive oestrogen stimulation --> excessive proliferation

Question 32

Histology of 4x stages of Menstrual cycle

Answer 32

1. Proliferation: proliferation mainly in basal layer. little tubules in dense stroma. 2. Secretory: (juicy/glandular) - serrated and convoluted glands - secreting substances to keep blastocysts happy --> breaks down/sheds upon no implantation

Question 33

Endometrial tumour table

Answer 33

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Question 34

Myometrial tumour table

Answer 34

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Question 35

Cervix

Answer 35

"neck" narrower portion of the uterus Cervix protrudes down into upper vagina

Question 36

Surface anatomy of cervix

Answer 36

Inferior Vagina --> Superior Cervix Squamous epi Endocervical canal glandular epithelium

Question 37

Tumour table of the cervix

Answer 37

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Question 38

Precancerous squamous intraepithelial lesion

Answer 38

CIN (cerivcal intraepithelial neoplasia) dysplasia squamous intraepithelial lesion - low grade squamous intraepithelial lesion (CIN) - high grade squamous intraepithelial lesion (CIN II and III)

Question 39

HPV virus multiplication

Answer 39

squamous mucosa beomces infected with HPV --> HPV virus integrates itself into DNA --> increased replication and turnover of the cell --> CIN

Question 40

Grade of pre-cancer

Answer 40

dependany on severity and extent of stypia CIN I CIN II CIN III Invasion - want to see these cellular changes during smear test

Question 41

CIN --> Invaded

Answer 41

neoplastic cells can invade into Blood vessels, nerve and lymphatics --> spread and metastasize

Question 42

Uterine Congenital abnormalities

Answer 42

Uterus doesnt fuse symmetrically - Intersex abnormalities - malformations of the uterus - abnomalities of ovarian development (Absent ovaries) e. g Bicornuate uterus: Pregnancies occurring on both sides of the uterus